Patients’ Week 2011: “Nothing can replace the human touch”
Stewart H Rosen, MD, VP medical affairs with Quintiles, and Valerie Metil, Quintiles' senior director of operations, health management solutions, on educating patients-and empowering them in the process
By on Jun 20, 2011Quintiles, which helps deliver new drugs and cures for some of the world's most challenging diseases, conducts programs in which nurses and other clinical educators visit patients to tell them about the disease they have been diagnosed with, how to cope with it, and the therapy they have been prescribed. Ursula Sautter spoke with Stewart H. Rosen, MD, VP medical affairs, and Valerie Metil, senior director of operations, health management solutions, about the company's patient-centric approach.
How successful are your programs and what feedback do you get from participants?
Valerie Metil: The key seems to be a combination of intense education and one-on-one human contact. Let's take an MS program we conducted. Certified nurses dedicated to this therapeutic area educated patients about the disease and proper medication administration as well as listened to their experiences and fears. The impact of this approach was demonstrated in one analysis that showed a 40% improvement in retention rates. In addition, there was a significant improvement in patient satisfaction and understanding of the importance of long-term therapy via patient survey.
So one key is providing people with knowledge?
VM: Correct. It's really very simple. We had found, for instance, that often rescue drugs for asthma are overprescribed and overused without education around the need for control therapy. Our program educated the physician and staff on overall asthma management and how to train patients on proper use of their inhalers. That boosted adherence and patient outcomes.
Stewart H. Rosen: Yes, you can have wonderful tools to remind a patient that he or she needs to take their meds but unless they understand the disease, its process, what impact the meds are going to have both in the short- and long-term and why it's fundamental to take it, that won't get you anywhere. The core question is not: Why are patients not compliant? The core is, understanding the disease and impact and then remove the barrier to taking the medication
VM: That's often especially important in case patients don't suffer from any noticeable symptoms. They don't understand why they have been put on these meds and why they need to take them.
But the human touch is also decisive?
SR: We hire folks who are experts in their field. For example, we will have Certified Diabetes Educators (CDEs) in our diabetes program. These people live and breathe diabetes. It's their passion. Patients recognize that. That is also crucial.
So patients have learned a lot from you. What have you learned from patients?
VM: A lot. At the start of our now seven-year-old MS program, when the average visit would require between 1 and 1.5 hours, we thought that the time we spend at people's homes would become shorter once we got more experienced at delivering our educational messages. The opposite turned out to be the case. We learned that at these visits, when the patients have just received the diagnosis, they need time to vent about what it means to them. Once they have time to share their fears, they are more open to receiving and processing the education.
SR: In our early days, our model was focused on training the trainers. But due to practice demands, health care providers would usually not have the time to instruct patients themselves-unless they had captive audiences, so to speak-as in the case of oncology, where patients receiving injectable or infused therapy have the opportunity to sit with the practice oncology nurse for an extended period of time to receive counseling.
What feedback do people give regarding the structure of the visits?
SR: We found, for example, that patients can be very nervous at first-time visits. We need to be careful not to overload the patient with information when there are so many key messages to impart. So we have learned how to prioritize the info we give and make sure we follow up with reinforcing messages in subsequent visits/calls or the tools that we provide the patient.
Do you pass on what you have learned?
SR: It is part of our job to keep healthcare providers in the loop. So already at a very early stage we get them acquainted with the educators we use. In a competitive environment, the quality of a support program offered is crucial in the determination of what brand is going to be prescribed. We also follow up with their doctors to share how the patients have reacted to their consultation and any potential barriers to care.
Are manufacturers included in this process?
VM: Sure, we also loop back to the manufacturers to let them know about any problems or barriers that come up. That's why we survey our patients and practices to find out how effective our nurses are, what patients and office staff are most likely to remember from an educational session.
So that would make patient-centric marketing possible?
SR: Patient comments about specific devices can also be the basis for product improvements conducted on the side of the manufacturer. Without going into specifics, that's what has happened for us in the case of a partner's device, for example-understanding the ease of use and what further improvements could be made.
What kinds of drugs or medical devices can benefit from this kind of program?
SR: Any disease that is of a chronic nature, from psoriasis to asthma, from MS to diabetes. Self-administrated injectables, device-managed or higher-cost biological therapies make up most of our direct to patient programs. It is imperative the patients understand their diagnosis, how the therapy will impact outcomes and how to appropriately manage their therapy.
Can families and caregivers benefit as well?
VM: Yes, educating those that give care is just as important. Here's an example. In an asthma program we conducted, the nurses showed a video explaining how to recognize when a patient was so unwell that they should be taken to the ER. A while later, one family, whose child was suffering from asthma, got back to us and told us that it was that video that enabled them to make the decision to rush him to hospital, something they wouldn't otherwise have done.
Programs like this don't come cheap, though.
SR: That's true. For the 1-on-1 patient interaction, they will usually only be feasible in the case of higher-cost drugs. With lower-cost drugs where the cost of goods cannot cover an individuated approach, we will take a virtual or group training approach. In the end, it all depends on the ability of the pharma company to subsidize such a financial burden.
Can costs be reduced using new media?
SR: Yes, and we are becoming more virtual all the time. This especially goes for reinforcement measures where online live contact via camera between nurses and patients has been confirmed to be successful.
VM: But nothing can replace the human touch.
For all of our Patients' Week 2011 stories, check out eyeforpharma's website in September.
For everything patient-related, join the sector's key players at Patient Adherence USA on October 24-25 in Philadelphia andMobile Innovation for Pharma on December 1-2 in London.
To read our Patients' Week stories from 2010, see Patients' Week 2010.